Hypertension Management

What Is Hypertension Management

Hypertension, or high blood pressure, is blood pressure that stays at 140/90 mmHg or higher. It usually causes no symptoms, but over the long term it strains the heart and damages the blood vessels in the brain, kidneys, and eyes. Hypertension management is long-term care to lower blood pressure to the target and keep it stable.

How It Works in Brief

High blood pressure forces the heart to pump harder and makes the walls of the blood vessels thicker and stiffer. Salt reduction, physical activity, and medicines work by widening the vessels, reducing excess fluid, and blocking hormones that narrow the vessels. A combined analysis of many studies shows that every drop of about 10 mmHg in the upper number reduces major cardiovascular events by roughly one fifth.

Confirming the Diagnosis and Assessing the Organs

Before treatment is started or changed, your blood pressure is confirmed with home measurements or 24-hour monitoring. These are covered on the Hypertension and Blood Pressure Screening, Home Blood Pressure Monitoring, and Ambulatory Blood Pressure Monitoring pages. Your doctor also checks kidney function, potassium, protein in the urine, blood sugar, cholesterol, and an ECG to assess organ damage and, in certain people, to look for causes of secondary hypertension. These are covered on the Kidney Function Test and Urine Protein-to-Creatinine Ratio (UPCR) pages.

Treatment Steps

• Reduce salt: limit salt to about 5 grams, or one teaspoon, per day, including hidden salt in processed foods, soy sauce, and flavor enhancers. Potassium-containing salt substitutes can help if your doctor allows them.
• Other lifestyle changes: moderate-intensity physical activity for at least 150 minutes per week, losing weight if you are overweight, limiting alcohol, and quitting smoking. This is covered on the Lifestyle Counseling and Risk Management page.
• Combination medicines: the majority of patients start with two low-dose medicines in one tablet, for example an ACE inhibitor or ARB together with a calcium antagonist or a diuretic, then the dose is increased or a third medicine is added if needed. This is covered on the Integrated Medication Therapy page.
• Resistant hypertension: if blood pressure is not controlled with three medicines, your doctor makes sure the medicines are taken regularly, looks for secondary causes, then adds a medicine such as spironolactone. Renal denervation may be considered in certain patients. This is covered on the Renal Denervation page.
• Coexisting conditions: diabetes, cholesterol, and kidney disease are also controlled because their risks add to each other. This is covered on the Dyslipidemia Management page.

Blood Pressure Target

The 2024 European guidelines recommend an upper number of 120 to 129 mmHg for the majority of treated patients, if tolerated. In frail older adults, or if dizziness occurs on standing, the target can be less strict. The aim is to reach the target within about 3 months.

There is no recovery period for a consultation. What matters is following your treatment plan consistently.

Take your medicines every day. Blood pressure rises again if medicines are stopped. Do not stop on your own even if your readings are normal or you have no symptoms.

Measure at home. Record the results regularly as advised by your doctor.

Reduce salt. Watch for hidden salt in instant noodles, canned foods, salted fish, soy sauce, and other sauces.

Stay active. Regular brisk walking, cycling, or swimming helps lower blood pressure.

Warning signs. Go to the emergency room right away if your blood pressure is 180/120 mmHg or higher with:

• Chest pain or shortness of breath
• Severe headache, confusion, or seizures
• A drooping face, arm weakness, or slurred speech
• Sudden vision problems